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Sexual and reproductive health in rheumatic disease

Nature Reviews Rheumatology volume 13, pages 485–493 (2017)Cite this article

Subjects

Key Points

  • The cause of reduced fertility in women and men with rheumatic disease is multifactorial and is related to disease activity, therapy, impaired sexual function and personal choices

  • At present, evidence for impairment of fertility is only robust for cyclophosphamide in both genders and for sulfasalazine in men; measurements for preservation of fertility should be initiated in both genders before or during early treatment with cyclophosphamide

  • NSAIDs can delay or temporary inhibit ovulation; the choice of type of NSAID, dosage and timing of NSAID administration can reduce the effect on ovulation.

  • The first step to avoid unintended infertility is to monitor sexual function and family planning routinely in all patients of fertile age to detect problems related to reproductive health.

  • Improvement of reproductive health is achieved by effective treatment of rheumatic disease, comprehensive counselling, and if needed, referral to specialists in sexual medicine and infertility.

Abstract

Family size is reduced among patients with rheumatic diseases. The causes for the low number of children are multifactorial and include impaired sexual function, decreased gonadal function, pregnancy loss, therapy and personal choices. Sexuality contributes to quality of life in patients with rheumatic disease, but is often ignored by health professionals. Both disease-related factors and psychological responses to chronic disease can impair sexual functioning. Toxic effects of anti-inflammatory and immunosuppressive drugs can induce transient or permanent gonadal failure in women and men. Furthermore, permanent infertility can be a consequence of treatment with cyclophosphamide, whereas transient infertility can be caused by NSAIDs in women and sulfasalazine in men. These adverse effects must be communicated to the patients, and measures to preserve fertility should be initiated before the start of gonadotoxic therapy. Management of patients of both genders should include regular family planning, effective treatment of high disease activity, sexual counselling, and, if necessary, infertility treatment.

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Figure 1: Reproductive health in patients with rheumatic diseases.

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  1. Department of Rheumatology, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Olav Kyrres Gate 13, Trondheim, N-7006, Norway

    Monika Østensen

  2. Department of Rheumatology, Sørlandet Sykehus, Egsveien 100, Kristiansand, 4615, Norway

    Monika Østensen

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Correspondence to Monika Østensen.

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The author has received speaker fees and consultant fees from Abbott/Abbvie, New Bridge, Pfizer, Roche and UCB.

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Østensen, M. Sexual and reproductive health in rheumatic disease. Nat Rev Rheumatol 13, 485–493 (2017). https://doi.org/10.1038/nrrheum.2017.102

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